The U.S. Coast Guard's Hawai'i district last month made a record number of emergency medical evacuations that was more than four times the typical monthly pace.

All told, the Coast Guard District 14 made 17 house calls on the high seas, including three in one day on three separate occasions. The emergencies ranged from a patient with food poisoning to a merchant seaman whose arm was severed in a shipboard accident while at sea.

"It was definitely a busy month," said Richard Roberts, who coordinates maritime medevac rescue missions for the Hawai'i district. "Medevacs are one of the more challenging duties for Coast Guard personnel because no two are ever the same."

The Hawai'i District typically responds to two to four emergency evacuation requests per month, Coast Guard spokeswoman Marshalena Delaney said.

"Last month was unusual," she said. "For no particular reason, people just needed our help more than usual."

In three of the cases, sick or injured patients were hoisted aboard a Coast Guard "Dolphin" helicopter and whisked away to a hospital for treatment.

Five others were loaded aboard C-130 airplanes to be flown to Honolulu from the Neighbor Islands or as far away as Guam and Midway.

In another five cases, injured or ill patients were brought to shore for medical treatment from ships or boats by various Coast Guard watercraft that range in size from a 23-foot rigid hull inflatable boat to one of three 110-foot steel hulled patrol boats.

In four other cases, the Coast Guard provided ground transportation or flight surgeon advice.

District 14 spans 12.2 million square miles, encompassing waters off Hawai'i, Guam and American Samoa.

When a call for help comes in, it is Roberts' job to coordinate efforts to get an injured or sick patient to a treatment facility as quickly as possible.

Time and distance are the two obstacles his office is constantly up against.

"We weigh out the risk-management issues first," said Roberts, now a civilian, but a former C-130 pilot himself with 16 years of active duty service in the Coast Guard. "Say, for instance, if we're going to launch a crew at midnight and have them go out in bad weather, what are the odds of saving the severed limb of someone who has been injured.

"We want to be able to have the patient — and the appendage — at the hospital within four to six hours if we are going to put a crew in jeopardy."

Launching that kind of a mission would also depend on discussions between a Coast Guard flight surgeon, who would get opinions from a vascular surgeon and other doctors as well, on how to proceed.

The gamut of medical problems include cardiac arrest, stroke, appendicitis, broken bones, severe bleeding, head trauma and spinal injury.

While the knowledge that a person in need has been helped counterbalances the stress, an occasional letter of thanks from a former patient is even better.

The Honolulu office recently received one such e-mail from Susan Peter, a 58-year-old Portland, Ore., housewife who left Nawiliwili Harbor on Kau'ai on a 36-foot sailboat with the skipper and two others in August for what she thought was going to be the trip of a lifetime.

Two weeks into it, on the brink of mental and physical exhaustion from not having eaten or taken any liquids for two or three days, Peter confided in the only other woman aboard that she felt she wouldn't last the additional two weeks or more it would take to reach the West Coast.

The other woman persuaded the reluctant skipper to call the Coast Guard for help.

Twelve hours later, the enormous container ship Rhein Bridge pulled up to the sailboat and hoisted Peter aboard.

"They gave me a cup of hot tea and I took a hot shower," said Peter, who had developed a bladder problem and was fearful she might be coming down with appendicitis, conditions she now attributes to stress.

"I felt my life was at risk. At the rate we were going, I didn't think I could hold out for another two weeks," she said.

Peter, contacted at her Portland home yesterday, said she was struck by the positive, professional manner with which she was treated by the Coast Guard.

"I expected to get the same kind of lecture I used to get from my mother: 'Well, dear, you shouldn't have gotten yourself in that predicament to begin with.' But, there was none of that."

The Rhein Bridge took Peter to Panama, and from there she was able to fly home to Portland. She later learned that the sailboat she was removed from took an additional four weeks to reach the Mainland.

As a command duty officer, Lt. j.g. John Titchen, is responsible for coordinating search and rescue and medevac missions within 200 miles of the Hawaiian chain. He says the job can be both challenging and exciting "especially when we're racing the clock."

It can also be "tremendously rewarding" when someone missing at sea is found or an injured person is brought to shore, said Titchen, who used be a crew member aboard Coast Guard planes and helicopters.

"You can see it in their faces, how badly these people needed help," Titchen said. "You can see it in their eyes."

Reach David Waite at dwaite@honoluluadvertiser.com.